Table of Contents

Table of Contents

Before a claim can be billed for its first time, its status must be Ready. Both the

Electronic Billing and HCF1500 icons will ignore the claims whose status isn’t

Ready. Once a claim has been billed (by either method), SchuyLab changes its status from Ready to Billed. At that point, if you want to rebill it, you must do one of two things:

Change the status from Billed back to Ready (through Edit Claims);

OR

Check the Rebill Previously Billed box through the HCF1500 (shown below) or

Electronic Billing icons. When this box is checked, these icons look for Billed claims, instead of Ready claims.

To Rebill Part of a Claim

You may need to rebill only one or two line items on a particular claim -- say, if

Medicare disallowed that test based on the ICD-9 code, and the doctor has since provided you with a new ICD-9 code to cover it. In that case, you can ‘freeze’ some of the lines of the claim, so that they aren’t available for rebilling. The other lines can then be edited as necessary, and rebilled. To do this:

1) Select Edit Claims and go to that claim

2) Choose the first line item you don’t want to appear on the rebill.

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3) Move the pointer to the place on the line right after the date (as illustrated below).

4) Click the mouse button and an asterisk * appears at the indicated position. This

means that the selected line item has been paid and will not be rebilled.

5) Repeat the above steps for all the line items that are not to be rebilled.

6) Now you can rebill the claim either electronically or on paper. You can set the claim status from Billed back to Ready, or you can go straight to the HCF1500 icon and use the Rebill Previously Billed check box. Either way, when you rebill, only those items without an asterisk will be rebilled.

Printing Reports

SchuyLab’s Billing Module has several report functions for tracking such things as unmailed claims, past-due claims, or claims for a given client. Three of these are accessed directly through the main Billing Module menu screen: Open Claims,

Claim Aging, and Batch Payments. The others are accessed through the Billing

Analysis icon.

There are also some reports that, while not billing reports as such, are often of interest to the billing department of your lab. These are the Patient Demographics,

Client Demographics, and Billing Demographics reports, accessed through the F6.

Print menu screen. The setup and use of these features are described more fully in

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the SchuyLab User’s Manual.

Open Claims

The Open Claims icon will print a list of all claims within a specified range that are still Open - that is, that have never been set to Ready or Billed. This is particularly useful for claims which are automatically be set to Ready when they meet defined criteria (for instance, that the patient’s date of birth and Medicare number are on file). Printing the Open Claims report would tell you which claims haven’t yet met those criteria, and why.

It’s very useful to print the Open Claims report immediately after having brought the claims to the Billing side via Bill Accessions. That way, you’ll have a list of the claims that will need to be amended through Edit Claims.

To print the Open Claims report:

From the Billing Module menu screen, select Open Claims.

SchuyLab displays the Print Open Claims box.

Enter the first and last claim numbers (i.e., specimen numbers) of the range to be included in the report and select the print queue to use. You can also click on

Setup… to assign the default print queue and font for all of your reports. You can also choose how you want your claims to be grouped together. In the Sequence drop down box you can choose to group claims by Client or by Bill Type (or leave blank to not group claims in any special manner). You can also choose to order your claims by Claim # or by Patient name by clicking the appropriate selection.

When you are done, select OK. SchuyLab prints the report.

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Claim Aging

The Claim Aging icon will print the claims for a given client, separated by aging category: 30 days aged, 60 days, 90 days, or 120+ days. (Note that a claim must be at least 30 days old before it will appear on this report!) The client’s name, the patient’s bill type (CASH, MEDICARE, &c.), and the aging category can all be specified.

To print the Claim Aging report:

From the Billing Module menu screen, select Claim Aging.

SchuyLab displays the Print Claim Aging box.

In the Select Billtype pull-down menu you can select a single bill type (CASH,

MEDICAL or MEDICARE for example) or leave it on all to print out all bill types.

In the Select claim age section you can choose all to print all aging categories or select from any combination of Current, 30, 60, 90 or 120+ days to display in your aging report.

In the Select for Client field, type in the name of the appropriate client. If you wish to print a report for all clients, leave the field blank.

You can select the sequence the data will appear from the Sequence pull-down menu. If you click off the Summary only, the report will display only the summary information. As before, you can change which queue it will print to with the queue pull-down menu, or change the default using the Setup button.

When all the fields are ready, select OK. SchuyLab prints the Claim Aging report.

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Batch Payments

The Batch Payments icon will print a report of the total payments that had been entered into the individual claims -- a simple form of accounts receivable. Each payment is assigned a Batch ID number (through the Batch field in the Edit

Payments box). Though you can invent your own system, SchuyLab will assign a

Batch ID number by default, and we recommend that users do this.

To print the Batch Payments report:

From the Billing Module menu screen, select Batch Payments.

SchuyLab displays the Print Batch box.

Enter the Batch ID number for the day you wish to report. By default, the Batch ID number is set by SchuyLab. It takes the form of a six-digit number: the year, then the month, then the day. For example, to see the Batch Payments report for June

27, 1998, enter “980627” as the Batch ID number.

When a Batch ID number has been entered, choose a print queue from the pulldown menu and select OK. SchuyLab prints the Batch Payments report.

Billing Analysis

The functions in Billing Analysis are more useful from a managerial viewpoint.

They’re similar in nature, which is why they’ve been grouped onto their own screen. The six functions -- Monthly Sales, 12 Month Revenue, Sales by Rep,

Client Accounts, Transaction Audit, and Sales Rep Transactions -- track the actual revenue flow according to date, client, and sales representative.

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To access the Billing Analysis screen:

From the Billing main menu screen, select Billing Analysis.

SchuyLab displays the Billing Analysis screen.

Each of these reports is accessed by its appropriate icon.

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Monthly Sales

The Monthly Sales function prints a sales report for a given date range, for any given client (or for all clients). To access the function, select the Monthly Sales icon. SchuyLab displays the Sales Report box.

In the Report Date Range fields, enter the beginning and ending dates for the report.

In the Client Name field, type the name of the client you want on the report; if you leave this field blank, the report will be for all your clients. You can change which queue it will print to with the queue pull-down menu, or change the default report settings using the Setup button.

When all the fields are ready, select OK. SchuyLab prints the Monthly Sales report. Each client’s section of the report will look something like this:

Client #1:

INSURE

MEDICARE

MEDICAID

TOTAL

# CLAIMS %

13 19

45 64

12 17

70

CHARGES %

355.00

19

1212.95

65

288.00

16

1855.95

PAYMENTS

180.00

635.00

301.78

1116.78

ADJUSTMENTS

0.00

0.00

0.00

0.00

WRITE-

OFFS

0.00

0.00

0.00

0.00

At the end of the report will be a summary for all the clients in the report.

Bear in mind that the dollar amounts -- charges, payments, write-offs, &c -- are those entered during the Report Date Range. They do not necessarily apply to the same claims. Thus, in the above example, the Medicaid payments for the month of

May don’t equal the Medicaid charges for the same month -- because the payments apply to charges from previous months, instead. They were the payments entered in May, not payments for the charges in May.

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12 Month Revenue

The 12 Month Revenue function prints a sales report for a full year, for any given client (or for all clients). To access the function, select the 12 Month Revenue icon. SchuyLab displays the 12 Month Receipts Report box.

Under the heading “Report Date Range”, two fields are shown. Type in the start and end date that you want the report to cover. In the Client Name field, type the name of the client you want on the report; leave this field blank if you want a report on all your clients. You can change which queue it will print to with the queue pull-down menu, or change the default report settings using the Setup button.

When all the fields are ready, select OK. SchuyLab prints the 12 Month Revenue report for the twelve-month period ending with the specified date.

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Sales by Rep

The Sales by Rep function prints a sales report for a given date range, for any given sales representative (or for all sales representatives). Sales representatives are initially entered as part of the definition of each client. If you were to select F8.

Tools, Doctor Records, Update Client, and select a client (or create a new client entry), you’d see the Update Client Record box:

The field labeled Sales is where the sales representative for that client is entered. It might be the rep’s initials, or a number, but it should be some unique identifier for that sales rep.

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Once that’s done, the Sales by Rep function can be used. To access the function, from the Billing Analysis menu screen, select the Monthly Sales icon. SchuyLab displays the Sales Report by Rep box.

In the Report Date Range fields, enter the beginning and ending dates for the report and select a print queue. When all is ready, select OK. SchuyLab prints the Sales by Sales Rep Report. The headings and layout are the same as the Monthly Sales

Report, above, but all the clients for each sales representative are collected together under the rep’s name. (There’s even a section for clients with no sales rep entered.)

Transaction Audit

On occasion, you may need to track down exactly when a payment was entered into

SchuyLab, or which claims were billed on the week of 1 April. For those occasions, the Transaction Audit prints out an audit trail of exactly what, when, and who, for every billing transaction in a given period.

To access this function, select the Transaction Audit icon. SchuyLab displays the

Sales Audit Report box.

In the Report Date Range fields, enter the beginning and ending dates for the report.

In the Client Name field, type the name of the client you want on the report; if you leave this field blank, the report will be for all your clients. You can select a print queue using the print queue pulldown menu.

When all the fields are ready, select OK. SchuyLab prints the Sales Audit by Bill

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Type report. It will simply list each transaction entered into SchuyLab during the selected interval: every charge, payment, write-off, or line edit. Each transaction will also include the date, time, SchuyLab operator ID, client ID#, bill type, and claim/accession number. Then, at the bottom of the report, it will print the summary-by-bill type as found in the Monthly Sales report.

Sales Rep Transactions

It is often helpful to separate a transaction audit by sales representative, rather than client. For this, select the Sales Rep Transactions icon. SchuyLab displays the

Sales Rep Audit Report.

In the Report Date Range fields, enter the beginning and ending dates for the report.

In the Client Name field, type the name of the client you want on the report; if you leave this field blank, the report will be for all your clients. If you click off the

Summary Only Report checkbox, you will only print the summary information. If needed, you can change the print queue using the Queue pulldown menu.

When all the fields are ready, select OK. SchuyLab prints the Sales Audit by Sales

Rep report. It will separate out, by sales representative, all the charges, payments, adjustments and write-offs for each claim, line by line, with totals at the bottom of the page. (Each sales rep’s numbers are on a separate page, so you can hand one rep his report without him seeing any other sales rep’s take.) Then, at the bottom of the report, it will print the summary-by-bill type for all sales reps.

Client Accounts

The Client Accounts function prints a report of the current status of each of your invoiced clients. This only applies to Client Invoicing, and not to any other type of claim -- it won’t, for instance, list the HCFA-1500 claims from a given client. (For that, you should use the Claim Aging report.) To access the function, select the

Client Accounts icon. SchuyLab displays the Client Accounts box.

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Here you can specify current Queue and Activity level, or go to Setup to specify default queue and font. In the Activity level box you have a few different choices.

All Accounts

This level will print listings for all accounts whether they have any activity or not.

Any Balance

Past Due 30+, Past Due 60+, Past

Due 90+

This level will print listings for all accounts that have a non zero balance.

These levels will print listings for all accounts with balances in the specified range. (i.e. 30 days or older,

60 days or older or 90 days or older)

Note that these settings determine which clients appear and which don’t, not what information is printed on those clients. In all cases, SchuyLab prints the Client

Account Status report, which looks something like this:

Current

Client #1

10.00

Client #2

0.00

30 Days

25.00

17.00

60 Days

0.00

212.56

90 Days

0.00

0.00

120+

Days

Balance

0.00

35.00

0.00

229.56

Last

Payment

3/1/98

12/31/97

TOTALS

10.00

42.00

212.56

0.00

0.00

264.56

Because the client accounts are cumulative, like your monthly credit card statement, the totals do add up and can be reconciled.

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Patient Accounts

Patients Accounts functions almost exactly the same as Client Accounts except instead of tracking outstanding Client Invoices it tracks outstanding Patient

Invoices. Patient Accounts also starts its options with Any Balance as including every patient in the database with no outstanding invoice would do nobody any good except for your lab’s printer paper supplier!

Claim Recap

Claim Recap will print you a report on any specified range of claims regardless of their current status.

Enter the first and last claim numbers (i.e., specimen numbers) of the range to be included in the report and select the print queue to use. You can also click on

Setup… to assign the default print queue and font for all of your reports. You can also choose how you want your claims to be grouped together. In the Sequence drop down box you can choose to group claims by Client or by Bill Type (or leave blank to not group claims in any special manner). You can also choose to order your claims by Claim # or by Patient name by clicking the appropriate selection.

Finally you can click the checkbox next to Print on separate_pages if you want a page break between every group that you specified in Sequence (This has no effect if you leave Sequence blank). When you are done, select OK. SchuyLab prints the report which will have columns for Claim #, Billtype, Date of Service, Patient

Name, Charges, Payments, Writeoff, Adjustments and Balance.

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Troubleshooting Claims

There will be occasions -- rare, we hope, but it happens to us all -- when you will have problems with some of your claims. Medical Billing is a complex topic, and we can’t cover all possibilities here, but some problems crop up more frequently than others, and there are remedies you can try. All of these examples assume that the problem is with the claim itself, before we even get to forms and invoices.

There are no procedures on my claim.

Presumably, you’ve gone to Edit Claims, and while the patient’s name and demographics were in the panel at the top of the screen -- and the claim number

(aka the accession number) was displayed -- there were no procedures to be seen.

The most probable cause is that the procedure codes (CPT codes and such) haven’t been entered yet. Go to Billing Setup, select Tests or Panels or Procedures (as appropriate), and enter the procedure codes and prices. Then go back to Billing, and use Bill Accessions to bring the claim across a second time.

I ordered an Arthritis Panel on a specimen, but the claim doesn’t show an Arthritis

Panel; it shows individual tests.

Two errors might have caused this. First, were all the tests on the Arthritis Panel actually done? (If you’re not sure, go to Edit Claims, and select the Results button. SchuyLab will display all the test results that were done on this specimen.)

If all the tests of the Arthritis Panel weren’t done -- say, they cancelled the Uric

Acid -- then SchuyLab couldn’t build an Arthritis Panel for billing. In that case, it would bill for the tests that were done, as separate line items.

If all the tests on the Arthritis Panel were done is the Arthritis Panel itself set up for billing? If the Arthritis Panel doesn’t have a procedure code, the Billing Module will ignore it (and bill its component tests as separate line items). Additionally, if the claim is a Medicare-style claim, the Arthritis Panel has to have its “CPT” check box checked. Both of these can be verified through Billing Setup, then Panels.

Select the Arthritis Panel and make sure it’s got its procedure code, and that its

“CPT” box is checked. Then go back to Edit Claims and hit the Price $ button.

If that still doesn’t work, there’s one more thing to try. I know it sounds crazy, but are you sure you only have one Arthritis Panel? I’ve seen labs that went through several lab managers, each of whom defined new panels to suit their own personal tastes. It may be that the Arthritis Panel you’ve set up for Billing isn’t the same as the Arthritis Panel the lab staff has been ordering. If you can, go to F8.Tools,

Setup, Test & Panel Definition, and finally Panel Definition. See how many

Arthritis Panels are defined in your system. (Then go to Screen Definition to see which one’s able to be ordered.)

I set up one fee schedule for my doctors, another for Medicare. When I look at the claim, the wrong prices are displayed for the procedures.

First, make sure that the patient’s demographics are correctly entered. To do this, from the Edit Claim screen, select the Demographics button. Is the patient’s Client correct? (Remember, the Client field determines who gets billed, not the Doctor field!) Is the patient’s Bill Type correct? If not, change them here, and then select

F10. Done, exit the Edit Claim screen, and use Bill Accessions to bring the claim across again.

If the patient’s demographics are accurate, then go to Billing Setup. Make sure the fee schedules you’ve defined are attached to the appropriate Bill Types, Insurance carriers, and Clients. (For instance, the “Medicare” fee schedule should be attached to the MEDICARE bill type, through the Bill Types icon. The schedule for Client

Billing should be attached to the client record, through the Clients icon. Insurance schedules should be attached to carriers via the Insurance icon. And so on.)

If the schedules are correctly attached, we have one more place to look. In Billing

Setup, select the Schedules icon. Make sure each schedule is correctly defined. In particular, make sure that the Medicare-style fee schedules have the “CPT Rules” box checked. Also, make sure that the “Pct” field has an entry other than zero. I know one user who had entered a Pct (which is the percentage of the standard price) of zero, and naturally, all the claims based on that schedule had prices of $0.00.

I ordered a Basic Metabolic panel on a Medicare patient. But the claim shows a

Basic Metabolic panel and an Electrolytes panel! I didn’t order ’Lytes. What gives?

What gives is that the Basic Metabolic panel wasn’t defined correctly on the ‘lab’ side of SchuyLab. Remember, whenever possible, a large panel should be built from smaller panels; otherwise, SchuyLab Billing will build both panels. In this particular case, the Basic Metabolic panel has seven tests: Glucose, BUN,

Creatinine, Sodium, Potassium, Chloride, and CO2. The Electrolytes panel has four tests: Sodium, Potassium, Chloride, and CO2, matching four of the tests on the

Basic Metabolic panel. So Basic Metabolic needs to be defined, not as seven tests, but as Electrolytes plus three tests.

To fix this, go to F8.Tools, Setup, Test & Panel Definition, and finally Panel

Definition. Select the Basic Metabolic panel, and change its definition to Glucose,

BUN, Creatinine, and the Electrolytes panel. Select OK, go back to Billing and

Edit Claims, look up the claim in question, and hit the Price $ button.

Chapter 3 - 4Client Billing

Overview of Client Billing

Client Billing creates an invoice for any of the Clients in your database. The invoice lists the patients’ names and specimen numbers, the procedures and prices for each patient, and the total amount due. The invoice also displays any past due amounts from previous invoices, and any new payments made to that Client’s account. Each invoice has a unique invoice number, automatically assigned to it by

SchuyLab.

An account is the record kept for each Client showing all the financial activity: invoices billed, payments received, adjustments made. The account number for a

Client is the same as his client ID number, but must be preceded by a “number sign”

(#). Payments and adjustments made to an account are entered through the Edit

Account icon, not through the Edit Invoice icon.

Bill types are the key to Client Invoicing. When defining bill types, you have a choice of payors to be billed through that bill type: Medicare, Medicaid, Insurance,

Patient, and Client. (Review Section II, Billing Setup, for more information.) Any bill type with “Client” chosen as a payor is available for Client Invoicing. For bill types with multiple payors, you must wait until the payor has rolled over to “Client” before using Client Invoicing; some bill types have only “Client” as a payor, and are intended solely for Client Invoicing (these are often given names like PHYSICN or

DOCTOR).

Obviously, in order to be billed to a Client, a patient’s claim must specify the

Client’s name -- either as part of the patient entry process (on the ‘lab’ side of the system), or through the Patient Demographics function of the Edit Claims icon (on the ‘billing’ side). When claims are written to an invoice, a transaction entry

“Invoice” (and the invoice number) is automatically made on each claim, the claim is zero-balanced, and the status of that claim is set to Closed. Thereafter, the balance due is handled as part of the invoice, rather than as individual claims.

There are four icons in the Billing module, specifically designed for use in Client

Billing and invoices: Create Client Invoices, Edit Account, Edit Invoice, and

Print Invoices.

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Create Client Invoices

Select this icon to generate your client invoices -- usually monthly, but they could be at any other regular interval. Once this function generates the invoices, they will automatically be printed. You can generate invoices for all your clients at once, or choose which clients to invoice at this time.

Edit Account

Use this icon to manage your invoices (deleting or repricing), enter payments, or make adjustments. To view the contents of a particular invoice, point and click at the invoice entry in the list box and SchuyLab displays that invoice. Once you’ve done that, and are looking at a particular invoice, you may view a claim on that invoice in the same manner: Point and click on the line item representing that claim, and SchuyLab displays the individual claim information. To ‘back out’ from the claim level and go back to the invoice, select F9. Cancel. SchuyLab returns you to the invoice. Do likewise to return again to the account level of processing.

Edit Invoice

The title here is a misnomer. This is intended as a view-only screen; do all of your processing of client accounts on either the account level or the claim level.

Nonetheless, to view an invoice, select this icon and input the invoice number.

Print Invoices

Use this icon to reprint a range of invoices. It’s also used to define the printer queue on which invoices are printed.

Generating Invoices

As with any other Billing function, the first step is to bring the claims from the ‘lab’ side to the billing side of SchuyLab. This is done using the

Bill Accessions icon, as described in Section III of the Billing Manual. Once that’s done, you can edit any claims that need your attention (via Edit Claims) -- or, since

PHYSICN bill types are usually defined to automatically set claims to Ready, you can generate your invoices immediately.

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